Independent Study Highlights Differences between Advanced Practice Providers and Neurologists in Monoclonal Antibody Disease-Modifying Therapies Use

Background: Survey fielded by an independent market intelligence agency which specializes in tracking the US disease-modifying therapy (DMT) market, including benchmarking new launch metrics, in multiple sclerosis (MS).

Objectives: Characterize the MS treatment and management patterns of Advanced Practice Providers (APPs) and compare to neurologists.

Methods: Fielded between August and October 2017, 53 US APPs provided responses to an online survey. Results were compared to a parallel survey of US 98 neurologists, fielded in August 2017.

Results: Even with no significant difference in primary practice types, APPs are more likely to practice in a setting with MS specialist(s), a significantly higher MS patient volume, and onsite infusion capabilities compared to surveyed neurologists.  When considering MS patient care, neurologists perceive APPs as most competent at diagnosing and managing relapses and symptoms.  APPs report not only significantly higher shares of natalizumab (12.8% vs 7.3% compared with neurologists) and alemtuzumab (3.4% vs 1.1%), but also appeared to be early adopters of ocrelizumab (81% of APPs vs 67% of neurologists) with a self-reported share more than double that reported by neurologists (6.4% vs 3.0%). Neurologists, on the other hand, report significantly higher shares of dimethyl fumarate, interferon beta-1b, interferon beta 1a (SC), and Sandoz’s glatiramer acetate. PML concern is less of a limiting factor in APPs’ use of monoclonal antibody (mAb) DMTs compared to neurologists, except for natalizumab which they rate similarly to neurologists. Likewise, more APPs report significantly lower concern with the risk-benefit profiles of the individual mAb DMTs (apart from daclizumab) compared with neurologists. Instead of safety, barriers to using infusion mAb DMTs are more related to reimbursement/payer restrictions and patient reluctance among APPs.

Conclusions: APPs, who are often tasked with oversight of onsite infusion capabilities, tend to manage clinically complex, relapsing patients who may be appropriate candidates for a DMT switch to a mAb therapy. With their significantly greater clinical experience and comfort with mAb agents, APPs may be especially influential in the uptake of this growing DMT class for the treatment of MS.